, Volume 470, Issue 8, pp 2154-2160
Date: 16 Jun 2012

Is Fixation Failure After Plate Fixation of the Symphysis Pubis Clinically Important?

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Topic
Trauma

Abstract

Background

Plate fixation is a recognized treatment for pelvic ring injuries involving disruption of the pubic symphysis. Although fixation failure is well known, it is unclear whether early or late fixation failure is clinically important.

Questions/purposes

We therefore determined (1) the incidence and mode of failure of anterior plate fixation for traumatic pubic symphysis disruption; (2) whether failure of fixation was associated with the types of pelvic ring injury or pelvic fixation used; (3) the complications, including the requirement for reoperation or hardware removal; and (4) whether radiographic followup of greater than 1 year alters subsequent management.

Methods

We retrospectively reviewed 148 of 178 (83%) patients with traumatic symphysis pubis diastasis treated by plate fixation between 1994 and 2008. Routine radiographic review, pelvic fracture classification, method of fixation, incidence of fixation failure, timing and mode of failure, and the complications were recorded after a minimum followup of 12 months (mean, 45 months; range, 1–14 years).

Results

Hardware breakage occurred in 63 patients (43%), of which 61 were asymptomatic. Breakage was not related to type of plate, fracture classification, or posterior pelvic fixation. Five patients (3%) required revision surgery for failure of fixation or symptomatic instability of the symphysis pubis, and seven patients (5%) had removal of hardware for other reasons, including late deep infection in three (2%). Routine radiographic screening as part of annual followup after 1 year did not alter management.

Conclusions

Our observations suggest the high rate of late fixation failure after plate fixation of the symphysis pubis is not clinically important.

One of the authors (TJSC) has or may receive payments, in any one year, an amount in excess of $10,000 from Stryker Trauma GmbH (Schönkirchen, Germany). The institutution of one or more of the authors (TJSC, AJW, JL, SACM) received funding from Stryker UK Ltd (Newbury, UK).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.
Each author certifies that his institution approved the human protocol for this investigation, which occurred at North Bristol NHS Trust, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at the Pelvic and Acetabular Reconstruction Unit, Frenchay Hospital, North Bristol NHS Trust, Bristol, UK.